The Role of Quality of Care in Health-related Quality of Life in Patients with IBD

Abstract

In the literature there are indications of associations between health-related quality of life (HRQoL) in inflammatory bowel disease and disease activity, psychological status, coping, stressful life events, and social support. The aim of this study was to examine whether a relation exists between quality of health care and HRQoL, taking possible confounding variables into account. For this purpose, one single questionnaire was compiled from existing validated questionnaires. A population-based inception cohort of 1056 patients with inflammatory bowel disease in eight countries, diagnosed 6 to 8 years prior to the study, was approached to participate. In total, 824 patients responded (78%), and 517 could be included in statistical analyses. It was shown that in inflammatory bowel disease HRQoL was indeed influenced by quality of care (particularly with regard to the parameters of "providing information," "costs," and "courtesy"), as well as by disease activity, psychological status, type of hospital, social support, stressful life events, and way of administration of the questionnaire. Patients with active disease had lower psychological status and HRQoL scores at the time of the survey than patients without active disease. However, quality of care scores did not differ between these groups. The care aspect "costs" was scored worse by CD compared with UC patients, probably caused by a potentially more expensive treatment. In conclusion, it is shown in a large exploratory study, for the first time, that in inflammatory bowel disease, quality of care has a significant role in determining health-related quality of life.

Inflammatory Bowel Disease: A Patient’s and Caregiver’s Perspective

“…Five different factors have been reported to be associated with HRQoL: disease activity [14][15][16], psychological status [17,18], coping patterns [19], and social support [20]. Furthermore, the method of administration of the questionnaire, either by interview or self-reported, appears to affect results, with better HRQoL scores seen from self-reporting questionnaires [14]. The productivity and the number of hours worked by patients in the survey was not substantially affected by symptoms, even though some school-aged children missed an entire school year (16.4% of CD and 9.4% of UC patients) and a minority of adults reported losing a job (10.0% CD and 8.8% of UC patients).…”

The Luebeck interview for psychosocial screening in patients with inflammatory bowel disease

“…HRQoL is determined by disease activity, psychologic status, social support, stressful life events, coping styles, and the quality of medical care. 46 Psychologic status (e.g., anxiety and mood disorders) and social support have already been addressed. Stressful life events are meaningful, at least from the patients' perspective.…”

Psychological treatment may reduce the need for healthcare in patients with Crohnʼs disease

“…4 Thus, the severity of illness in IBD patients does not necessarily predict the hospital admission rate. 5 Due to its chronicity, Crohn's disease (CD) not only leads to physical complaints but also causes many patients to develop psychological symptoms 6 -12 that may influence their health-related quality of life [13][14][15][16] and care-seeking behavior. There is evidence that psychosocial factors accelerate the progression of CD.…”